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Thursday, June 8, 2017

Shining Light on Conflicts of Interest

Craig KlugmanThe American Journal of Bioethics Volume 17, 2017 - Issue 6
Chimonas, DeVito and Rothman (2017) offer a descriptive target article that examines physicians' knowledge of and reaction to the Sunshine Act's Open Payments Database. This program is a federal computer repository of all payments and goods with a worth over $10 made from pharmaceutical companies and device manufacturers to physicians. Created under the 2010 Affordable Care Act, the goal of this database is to make the relationships between physicians and the medical drug/device industry more transparent. Such transparency is often touted as a solution to financial conflicts of interest (COI). A COI occurs when a person owes featly to more than one party. For example, physicians have fiduciary duties toward patients. At the same time, when physicians receive gifts or benefits from a pharmaceutical company, they are more likely to prescribe that company's products (Spurling et al. 2010). The gift creates a sense of a moral obligation toward the company. These two interests can be (but may not be) in conflict. Such arrangements can undermine a patient's trust with his/her physician, and more broadly, the public's trust of medicine.

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The idea is that if people are told about the conflict, then they can judge for themselves whether the provider is compromised and whether they wish to receive care from this person. The database exists with this intent—that transparency alone is enough. What is a patient to do with this information? Should patients avoid physicians who have conflicts? The decision is left in the patient's hands. Back in 2014, the Pharmaceutical Research and Manufacturers of America lobbying group expressed concern that the public would not understand the context of any payments or gifts to physicians (Castellani 2014).